Haahtela T, Järvinen M, Kava T, Kiviranta K, Koskinen S, Lehtonen K, Nikander K, Persson T, Reinikainen K, Selroos O
Helsinki University Central Hospital, Finland.
N Engl J Med. 1991 Aug 8;325(6):388-92. doi: 10.1056/NEJM199108083250603.
The presence of airway inflammation even in mild asthma points to the potential value of antiinflammatory therapy. We compared the effect of an inhaled corticosteroid, budesonide, with that of an inhaled beta 2-agonist, terbutaline, in the long-term treatment of newly detected asthma.
We studied 103 patients (29 male and 74 female patients 15 to 64 years old) in whom asthma had appeared within the previous year. The patients were randomly assigned in blinded fashion to two treatment groups: one to receive 600 micrograms of inhaled budesonide twice a day, and the other to receive 375 micrograms of inhaled terbutaline twice a day. The study period was two years.
After six weeks of treatment, the patients treated with budesonide tolerated inhaled histamine better than the patients treated with terbutaline (a difference of one doubling dose step, P less than 0.001), and the difference was sustained. Patients' diaries kept during the first three months of the study and during the last month of the first and second years showed budesonide to be more effective than terbutaline in improving peak expiratory flow in the morning (average increase from the pretreatment value, 32.8 liters per minute for budesonide vs. 4.8 liters per minute for terbutaline; P less than 0.001) and in the evening (P less than 0.01). Budesonide was also more effective in reducing the symptoms of asthma (P less than 0.01) and the use of supplemental beta 2-agonist medication (P less than 0.01). Ten patients were withdrawn from the terbutaline group because treatment was insufficiently effective, whereas only one dropped out of the budesonide group. The adverse reactions to both treatments were few and mild.
Antiinflammatory therapy with inhaled budesonide is an effective first-line treatment for patients with newly detected, mild asthma, and it is superior to the use of terbutaline in such patients.
即使在轻度哮喘患者中也存在气道炎症，这表明抗炎治疗具有潜在价值。我们比较了吸入性皮质类固醇布地奈德与吸入性β2受体激动剂特布他林在新诊断哮喘长期治疗中的效果。
我们研究了103例（29例男性和74例女性，年龄15至64岁）在过去一年内出现哮喘的患者。患者以盲法随机分为两个治疗组：一组每天两次吸入600微克布地奈德，另一组每天两次吸入375微克特布他林。研究期为两年。
治疗六周后，布地奈德治疗的患者比特布他林治疗的患者对吸入组胺的耐受性更好（相差一个加倍剂量步长，P<0.001），且这种差异持续存在。在研究的前三个月以及第一年和第二年的最后一个月患者所记的日记显示，布地奈德在改善早晨呼气峰值流速方面比特布他林更有效（与治疗前值相比平均增加，布地奈德为每分钟32.8升，特布他林为每分钟4.8升；P<0.001），在晚上也是如此（P<0.01）。布地奈德在减轻哮喘症状（P<0.01）和减少补充性β2受体激动剂药物的使用（P<0.01）方面也更有效。特布他林组有10例患者因治疗效果不佳退出，而布地奈德组只有1例退出。两种治疗的不良反应均较少且轻微。
吸入布地奈德进行抗炎治疗是新诊断的轻度哮喘患者的一种有效一线治疗方法，在此类患者中它比特布他林更具优势。
